Concussion Assessment in Football and Soccer Players

AMSSM Research Abstracts (Clin J Sport Med 2004;14:310–311) Concussion Assessment in Football and Soccer Players Suzanne Hecht,* James C. Puffer,† Clifford Clinton,‡ Bassil Aish,§ Philip Cohen, Andrew Concoff,¶ Robert Hosey,# Alex Lai,* Joseph Luftman,** Henry Tsai* Daniel Vigil.** *UCLA Sports Medicine, Los Angeles, CA 90095, †American Board of Family Practice, Lexington, KY, ‡David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, §Huntington Beach, CA, Rutgers University Health Services, New Brunswick, NJ, ¶University of Texas—Houston, Houston, TX, #University of Kentucky, Lexington, KY, **Kaiser Permanente Sports Medicine, Los Angeles, CA. Purpose: This longitudinal study examined the reliability and clinical utility of the Standardized Assessment of Concussion (SAC) in football and soccer players over 4 years. Methods: The SAC is a brief sideline examination developed in accordance with the American Academy of Neurology and the Colorado Guidelines to evaluate neuropsychological changes following a concussion. Baseline SAC evaluations were administered to 691 athletes from 1997 to 2001 (198 NCAA Division 1 and 410 high school football players, and 83 NCAA Division 1 soccer players). The SAC was repeated on days 0, 1, 3, and 10 following concussion to the concussed player and a paired nonconcussed control player. Results: Reliability testing revealed intrarater and interrater reliability correlation coefficients equal to 0.74 and 0.60, respectively. Seventy-seven players suffered 87 concussions, with 99% of the concussions occurring in football players. The mean SAC score of concussed players was significantly decreased on day 0 compared to their mean baseline score (24.9 ± 3.9 vs. 27.0 ± 1.7; P < 0.0001) Nonconcussed control players’ mean SAC scores on day 0 significantly increased compared to their mean baseline SAC scores (26.9 ± 2.3 vs. 27.8 ± 1.8; P = 0.001). The mean difference of day 0 SAC scores in concussed players was significantly decreased as compared to their paired, nonconcussed controls. No significant difference was seen on day 1. On day 0, 29% of concussed players achieved a SAC score greater than their baseline score, and 100% of those players were symptomatic at the time of testing. Conclusions: The SAC is a reliable test. The clinical utility of the SAC is limited since 1/3 of players were able to improve their SAC score while still symptomatic from a concussion. Cumulative Effects of Concussion in High School and College Athletes Douglas B. McKeag,* Micky Collins,† Mark R. Lovell,† Corrine Ganglion.‡ *IU Sports Medicine, Indianapolis, IN, †UPMC Center for Sports Medicine, Pittsburgh, PA, ‡Sports Concussion Program, Pittsburgh, PA. Purpose: The potential cumulative effects of concussion are poorly understood. One prior study (Collins et al., JAMA. 1999;282:964–970) utilized traditional neuropsychological measures in college athletes and found deficits in speed of processing in those sustaining 2 or more prior concussions. With the recent advent of computerized neuropsychological testing, potential exists for large databases of pertinent information regarding concussion. Moreover, there is no current data examining the cumulative effects of concussion in high school athletes. The current study was designed to evaluate these issues in a very large sample of high school and college athletes. Methods: A total of 2553 high school and college athletes underwent preseason computerized neuropsychological testing utilizing ImPACT. Controlling for years of education, 3 groups were compared on their baseline ImPACT performance: those with no history of concussion (43%; n = 1098), those with 1 prior concussion (37%; n = 945), and those with 2 or more prior concussions (20%; n = 510). Results: Multivariate analysis of covariance revealed significant differences between the three groups across processing speed (PS) and reaction time (RT) composite scores (F = 4.18; P < 0.002). There was a significant decrease in processing speed and increase in reaction time (both worse performances) in the 1 (PS, mean = 35.8; RT, mean = .579) and 2 or more (PS, mean = 35.0; RT, mean = .587) concussion groups when compared to those sustaining no prior concussions (PS, mean = 36.1; RT, mean = .568). Conclusions: The cumulative effects of concussion appear to involve a decrease in mental processing speed and increase in reaction time. These data derived from ImPACT are consistent with previous data utilizing paper and pencil measures. The current analysis is the first to suggest cumulative effects of concussion in high school athletes. The Neuropsychological Consequences of Participation in an Amateur Boxing Tournament James Moriarity,* Alexander Collia,†‡ David Olson,§ John Buchanan, Patrick Leary,* Michael McStephen,† Paul McCrory.‡ *University of Notre Dame, Notre Dame, IN, †CogState Ltd., Melbourne, Victoria, Australia, ‡University of Melbourne, Parkville, Victoria, Australia, §Wauwatosa, WI, Mercy Walworth Medical Center, Lake Geneva, WI. Context: Participation in professional boxing has been demonstrated to cause chronic cognitive injury. Few studies have reported the acute cognitive function in amateur boxers postbout and none have documented the effects of repeated boxing bouts within a short time frame. Objective: To determine whether repeated concussive and subconcussive head trauma sustained by amateur boxers during a 7-day tournament causes an acute deterioration in cognitive performance. Study Design: Prospective study of 82 collegiate amateur boxers with no history of recent concussion or past history of brain injury who participated in a 7-day single-elimination boxing tournament. Neuropsychological assessment using the CogSport computerized test battery was performed at baseline and after each bout. Main Outcome Measure: Change in postbout neuropsychological performance when compared to the boxer’s own baseline performance. The cognitive tests administered in this study are simple reaction time, complex reaction time, 1-back, and continuous learning. These tasks measure psychomotor function/information processing, decision-making, working memory, and new learning, respectively. Results: The 82 study subjects fought a total of 159 times. CogSport testing was performed in 142 of the possible 159 postbout opportunities for testing. The postbout neuropsychological performance of boxers participating in 3 bouts was equivalent to that of boxers participating in 1 bout or 2 bouts. No significant changes from baseline performance were observed in any individual boxers, including those receiving standing 8 counts or for whom the referee stopped the contest. Conclusions: Amateur boxing conducted in a supervised competition does not result in acute cognitive impairment, even in boxers subjected to repeated bouts over a short time frame. CHAMPS: Characteristics of Athletic Medical Providers Study: A National Look at Sports Medicine Within Primary Care 2002 Christy Tharenos, Dan Vinson. University of Missouri–Columbia, Columbia,